Neurosurgery Coding Alert

Question: A 35-year-old mountain biker lost control of their bike during a competition, falling down an embankment and temporarily losing feeling and movement of their lower limbs. They were airlifted to a trauma center where evaluation revealed a traumatic burst fracture of T10 with some angulation (kyphosis) and cord compression. Mild weakness of the lower limbs was still present. The spine surgeon evaluating the patient recommended a thoracic corpectomy with anterior arthrodesis and reconstruction using a cage, stabilizing plate, and local autograft followed by posterior non-segmental spinal instrumentation.

Given the thoracic location and need for diaphragmatic dissection, the spine surgeon consulted with a thoracic surgeon to assist with the approach and closure. The two surgeons worked together as primary surgeons, with the thoracic surgeon performing the approach and closure and the spine surgeon performing the corpectomy, reconstruction and instrumentation. A lateral thoracotomy is performed with dissection of the diaphragm by the thoracic surgeon, after which the spine surgeon removes the fractured T10 vertebra, places a titanium cage in the defect packed with local bone autograft, and affixes an anterior plate from T9-T11. After the thoracic surgeon repairs the diaphragmatic exposure and closes the thoracotomy, the spine surgeon performs posterior non-segmental instrumentation from T9-T11 for additional stabilization.

Which CPT^® codes should I report for this encounter, and for which surgeon?

Texas Subscriber

Answer: We’ll code for both surgeon’s services, starting with the thoracic surgeon. They would report

• 63087 (Vertebral corpectomy (vertebral body resection), partial or complete, combined thoracolumbar approach with decompression of spinal cord, cauda equina or nerve root(s), lower thoracic or lumbar; single segment) for the approach and closure of the thoracolumbar junction procedure.
• Modifier 62 (Two surgeons) appended to 63087.

The spine surgeon would report:

• 63087 with modifier 62 appended for the approach and closure.
• 22556 (Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); thoracic) for the anterior interbody arthrodesis.
• Modifier 51 (Multiple procedures) appended to 22556 to indicate multiple procedures.
• +22585 (Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); each additional interspace (List separately in addition to code for primary procedure)) for the anterior arthrodesis.
• +22854 (Insertion of intervertebral biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to vertebral corpectomy(ies) (vertebral body resection, partial or complete) defect, in conjunction with interbody arthrodesis, each contiguous defect (List separately in addition to code for primary procedure)) for the anterior cage placement after corpectomy.
• +22845 (Anterior instrumentation; 2 to 3 vertebral segments (List separately in addition to code for primary procedure)) for the anterior plate fixation,
• +20936 (Autograft for spine surgery only (includes harvesting the graft); local (eg, ribs, spinous process, or laminar fragments) obtained from same incision (List separately in addition to code for primary procedure)) for the local autograft placed in the cage.
• +22840 (Posterior non-segmental instrumentation (eg, Harrington rod technique, pedicle fixation across 1 interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, facet screw fixation) (List separately in addition to code for primary procedure)) for the posterior T9-T11 spinal instrumentation.

Note: Since your description indicated that the thoracic surgeon assisted with only the thoracic corpectomy, that is the only procedure on which the providers were considered co-surgeons. If the thoracic surgeon assisted in other portions of other surgeries, they might be able to report those codes with modifier 80 (Assistant surgeon). Don’t report any codes other than 63087 for the thoracic surgeon unless you’re absolutely sure that the they had a role in the other surgeries.